1
Q
furosemide (Lasix) class
A
parenteral and enteral loop diuretic
2
Q
furosemide (Lasix) MOA
A
acts in the thick segment of ascending limb of Henle’s loop to block reabsorption of Na and Cl to prevent passive reabsorption of water
3
Q
furosemide (Lasix) indications
A
- pulmonary edema from HF
- edema non-responsive to other agents
- HTN not controlled by other agents
4
Q
furosemide (Lasix) AEs
A
- decreased Na, Cl, K, and BP
- transient ototoxicity; increased risk with other ototoxic meds
- dehydration; with increased risk for thrombosis emboli
- ventricular dysrhythmias with concurrent digoxin use
5
Q
furosemide (Lasix) nursing considerations
A
- monitor: I/O, VS, weight, hearing, electrolytes
- slow IVP (10-20 mg/min)
- admin in morning or early afternoon
- education on potassium-rich sources in diet
6
Q
hydrochlorothiazide (Thiazide) class
A
enteral thiazide diuretic
7
Q
hydrochlorothiazide (Thiazide) MOA
A
acts in the early segment of the DCT to block reabsorption of Na and Cl to prevent passive reabsorption of water and modest diuresis
8
Q
hydrochlorothiazide (Thiazide) indications
A
- essential HTN
- edema secondary to HF, hepatic or renal disease
- DI
- postmenopausal osteoporosis
9
Q
hydrochlorothiazide (Thiazide) AEs
A
similar to loop diuretic, but no ototoxicity
10
Q
hydrochlorothiazide (Thiazide) nursing considerations
A
- contraindicated in pts with low GFR
- monitor: I/O, VS, weight, electrolytes
- admin in morning or early afternoon
11
Q
spironolactone (Aldactone) class
A
enteral potassium-sparing diuretic/aldosterone antagonist
12
Q
spironolactone (Aldactone) MOA
A
blocks the action of aldosterone in the distal nephron to produce diuresis; little UOP as monotherapy, often combined with others
13
Q
spironolactone (Aldactone) indications
A
- essential HTN when co-administered with potassium-wasting diuretics
- edema
- HF
14
Q
spironolactone (Aldactone) AEs
A
- hyperkalemia
- endocrine effects: menstrual irregularities, impotence, deep voice, and hirsutism
15
Q
spironolactone (Aldactone) nursing considerations
A
- monitor: I/O, VS, weight, electrolytes
- educated pt on monitoring intake of potassium-rich sources in diet
16
Q
mannitol (Osmitrol) class
A
parenteral osmotic diuretic
17
Q
mannitol (Osmitrol) MOA
A
once filtered in nephron, creates osmotic force that inhibits passive reabsorption of water; increases serum osmolality to draw fluid back into vascular and extravascular space
18
Q
mannitol (Osmitrol) indications
A
- prophylaxis of renal failure w/ hypovolemic shock and severe hypotension
- reduction of intracranial and intraocular pressure
19
Q
mannitol (Osmitrol) AEs
A
- edema (especially with existing HF)
- fluid and electrolytes imbalance
20
Q
mannitol (Osmitrol) nursing considerations
A
- use filter needles and IV tubes
- store at room temp to prevent crystallization
- monitor for changes in ICP (if severe decline in urine output STOP MED!)
21
Q
lisinopril (Zestril) class
A
ACE inhibitor
22
Q
lisinopril (Zestril) MOA
A
reduce level of angiotensin II through inhibition of ACE and increase levels of bradykinin to dilate blood vessels, reduce blood volume, and prevent/reverse changes in heart and blood vessels mediated by angiotensin II and aldosterone
23
Q
lisinopril (Zestril) indications
A
- HTN, HF, and post-MI
- prevention of MI, CVA, and death in pts with high CV risk
- diabetic neuropathy
24
Q
lisinopril (Zestril) AEs
A
- first dose (syncope) hypotension
- dry cough
- angioedema (due to increased bradykinin)
- hyperkalemia (secondary to suppression to aldosteron release)
- fetal injury
25
lisinopril (Zestril) nursing considerations
- monitor: BP, electrolytes, daily weights
- educate pt: changing positions slowly, contact provider if angioedema or dry cough occurs, and potassium intake
26
losartan (Cozaar) class
angiotensin II receptor blocker (ARB)
27
losartan (Cozaar) MOA
blocks the actions of angiotensin II by blocking blocking access to its receptors in blood vessels, adrenals, and other tissues to cause dilation of vessels, prevent cardiac structural changes, and release of aldosterone
28
losartan (Cozaar) indications
- HTN
- HF
- reduce stroke risk, MI, and death in pts with high CV risk
- diabetic neuropathy and retinopathy
29
losartan (Cozaar) AEs
- angioedema (lower risk than ACE)
- fetal injury
30
losartan (Cozaar) nursing considerations
- ARBs used if pt not tolerating ACE due to cough
- monitor BP
- educate pt to contact provider if angioedema occurs
31
liskiren (Tekturna) class
enteral direst renin inhibitor
32
liskiren (Tekturna) MOA
binds with renin to inhibit cleavage of angiotensinogen into angiotensin I to reduce influence of entire RAAS
33
liskiren (Tekturna) indications
hypertension
34
liskiren (Tekturna) AEs
- diarrhea
- fetal injury
35
liskiren (Tekturna) nursing considerations
monitor: VS, I/O, weight, electrolytes
36
nifedipine (Procardia) class
duhydropyridine calcium channel blocker
37
nifedipine (Procardia) MOA
blocks calcium channels on vascular smooth muscle with minimal activity on heart
38
nifedipine (Procardia) indications
- HTN
- angina pectoris
39
nifedipine (Procardia) AEs
- peripheral edema
- flushing
- headache
- dizziness
- reflex tachycardia
40
nifedipine (Procardia) nursing considerations
- assess BP before admin
- monitor: reflex tachycardia, edema, daily weight
- add diuretic for peripheral edema
41
verapamil (Calan) class
non-dihydropyridines calcium channel blocker
42
verapamil (Calan) MOA
blocks calcium channels on the heart and blood vessels
43
verapamil (Calan) indications
- HTN
- angina pectoris
- dysrhythmias
44
verapamil (Calan) AEs
- constipation
- cardiac depression risk in pts with bradycardia, HF, and AV heart block
45
verapamil (Calan) nursing considerations
- assess BP before admin
-monitor edema and daily weight
- monitor interactions with other cardiac meds
- avoid grapefruit juice (toxicity!)
- if toxicity occurs: gastric lavage, activated charcoal, IVF, IV calcium gluconate, and trendelenburg
46
hydralazine (Apresoline) class
enteral and parenteral vasodilator
47
hydralazine (Apresoline) MOA
causes dilation of arterioles through actions on vascular smooth muscle to reduce peripheral resistance and BP. Not much significance on vein, which decreases risk of orthostatic hypotension
48
hydralazine (Apresoline) indications
- essential HTN
- hypertensive crisis
- HF
49
hydralazine (Apresoline) AEs
- reflex tachycardia
- renin release
- fluid retention
- SLE-like syndrome
50
hydralazine (Apresoline) nursing considerations
- monitor BP (for hypotension)
- reducing reflex tachycardia renin release by combining with beta-blocker
- combine with diuretic to reduce risk of sodium and water retention
- combine with isosorbide dinitrate to treat HF
51
nitroprusside (Nipride/Nitropress) class
parenteral vasodilator
52
nitroprusside (Nipride/Nitropress) MOA
causes both venous and arteriolar dilation to decrease BP
53
nitropursside (Nipride/Nitropress) indications
- used only for hypertensive emergencies
- controlled hypotension during surgery to reduce bleeding
54
nitropursside (Nipride/Nitropress) AEs
- excessive hypotension
- cyanide poisoning
- thiocyanate toxicity
55
nitropursside (Nipride/Nitropress) nursing considerations
- continuous monitoring of BP and electrocardiogram
- initial infusion rates range from 0.3-0.5 mcg/kg/min then titrate slowly to bring down BP (avoids cyanide poisoning)
- simultaneously coadminister with PO antihypertensives
- immediate effects trigger Na and water retention (manage with furosemide administration)
56
metoprolol (Lopressor) class
beta-blocker
57
metoprolol (Lopressor) MOA
decreases contractility which allows ventricles to fill by decreasing/blocking SNS to reduce electrical transmission in heart's conduction system to decrease HR and BP
58
metoprolol (Lopressor) nursing considerations
- assess BP and HR before administration
- start with low dose (full benefits seen between 1-3 months)
59
What is the drug of choice for severe HF?
furosemide
60
digoxin (Lanoxin) class
cardiac glycoside
61
digoxin (Lanoxin) MOA
inhibition of Na, K, ATPase leads to increased inotropic action, which then leads to increased CO (inc. inotrope action = increases forces of contractions)
62
digoxin (Lanoxin) indications
- 2nd line therapy for HF pts due to its toxicity
- multiple drug interactions
treats symptomatic HF and a-fib
- does not prolong life
63
digoxin (Lanoxin) AEs
- GI upset
- CNS effects = fatigue, HA, blurred vision
- dysrhythmias (hypokalemia secondary to diuretic use)
64
digoxin (Lanoxin) nursing considerations
- potassium supplements
- monitor EKG, K levels, establish baseline vitals
- monitor digoxin level (normal daily dose: 0.125mg PO QD)
- narrow therapeutic range (0.5-2ng/mL)
- check apical pulse before ( < 60 bpm)
- reinforce lifestyle modifications
- antidote for severe toxicity = Digiblind/Digifab/Questran
65
SVT meds
- BB = class II
- CCB = class IV
- digoxin and adenosine = class V
66
a-fib meds
- BB = class II
- CCB = class IV
- anticoagulants = warfarin, apixiban, dabigtran, rivaroxaban, edoxaban
- antiplatelets = ASA, clopidogrel (Plavix)
67
atrial flutter meds
- Class I Na channel blocker
- amiodarone = Class III K channel blocker
68
v-tach meds
immediate tx: cardioversion
- amiodarone = class III K channel blocker
- lidocaine = class IB- Na channel blocker
69
Torsades de Pointes meds
- IV mag sulfate
- Class I Na channel blocker
- Class III K channel blockers - amiodarone
70
v-fib meds
- defibrillation is priority
- Class I Na channel blockers
- Class III K channel blockers = amiodarone
71
quinidine (Quinidex) class
Class I Na channel blocker (Class 1A - immediate action)
72
quinidine (Quinidex) MOA
- prolonged depolarization and delay repolarization
- EKG shows widened QRS and prolonged QT interval
73
quinidine (Quinidex) indications
- drug of choice for malaria
- SVT
- ventricular dysrhythmia
74
quinidine (Quinidex) AEs
- watch for vasodilatino and hypotension (lightheadedness)
- diarrhea frequent
- blurry vision
- bitter taste
- tinnitus
75
quinidine (Quinidex) nursing considerations
if taken with digoxin, it doubles digoxin levels
76
lidocaine (Xylocaine) class
Class I Na channel blocker (Class 1B - very fast action)
77
lidocaine (Xylocaine) MOA
- local anesthetic
- decreased automaticity and accelerated repolarization
- EKG shows little to no effect
78
lidocaine (Xylocaine) indications
- local anesthesia
- short term therapy for ventricular dysrhythmias only
79
lidocaine (Xylocaine) AEs
CNS effects (confusion and drowsiness)
80
lidocaine (Xylocaine) nursing considerations
- given IV
- can also be given intradermal, topical
81
flecainide (Tambocor) class
Class I Na channel blocker (Class 1C - very slow action)
82
flecainide (Tambocor) MOA
reduce conduction velocity in atria, ventricles, and His-Perkunje system; delays repolarization and increased refractory period; EKG shows prolonged PR interval and widening of QRS
83
flecainide (Tambocor) indications
severe ventricular dysrhythmias not responsive to other meds
84
propanalol (Inderal) class
beta-blocker
85
propanalol (Inderal) MOA
- BBs blocks B1 and B2 adrenergic receptors which slows HR/slows time for conduction and decreases force of contraction
- beta blockage results in: decreased automaticity of SA node, decreased velocity through AV node, decreased myocardial contractility
- EKG shows prolonged PR interval
86
propanalol (Inderal) indications
- afib
- tachycardias
87
propanalol (Inderal) AEs
- heart failure/AV block
- hypotension
- bronchospasm
- contraindicated in pts with astham/COPD
88
amiodarone (Pacerone) class
K potassium channel blocker (Class III)
89
amiodarone (Pacerone) MOA
- delay repolarization = prolonged action potential duration and effective refractory period
- EKG shows widening QRS, prolonged PR and QT intervals
90
amiodarone (Pacerone) indications
serious dysrhythmias due to toxicities (v-tach and v-fib)
91
amiodarone (Pacerone) AEs
severe organ toxicities (lung damage, visual impairment, sun exposure turns the skin blue-gray)
92
amiodarone (Pacerone) nursing considerations
- monitor drug interactions (increases digoxin, warfarin, and statin levels)
- grapefruit juice increases levels
93
verapamil (Calan) and diltiazem (Cardizem) class
Ca channel blockers (Class IV)
94
verapamil (Calan) and diltiazem (Cardizem) MOA
decreased contractions, vasodilates blood vessels, similar to BBs
95
verapamil (Calan) and diltiazem (Cardizem) indications
- effective in controlling Afib and ventricular dysrhythmias
- chronic HTN as second-line therapy
96
verapamil (Calan) and diltiazem (Cardizem) AEs
for verapamil: constipation, dizziness, pedal edema, bradycardia
97
verapamil (Calan) and diltiazem (Cardizem) nursing considerations
for verapamil: food and drug allergies (digoxin, grapefruit juice, beta blockers), verapamil toxicity (severe hypotension, bradycardia, AV block)
monitor: VS, increase fluids, daily weights, I/O
98
adenosine (Adenocard) class
other antidysrhythmic
99
adenosine (Adenocard) MOA
decreases electrical activity in SA node and slows conduction through AV node to decrease heart rate
100
adenosine (Adenocard) indications
SVT
101
adenosine (Adenocard) AEs
- passes quickly
- sinus bradycardia
- dyspnea due to bronchoconstriction
102
adenosine (Adenocard) nursing considerations
- requires fast IVP
- give IV via PICC or central line
- must be on a monitor
103
nitroglycerin class
organic nitrates
104
nitroglycerin MOA
- in chronic stable angina, nitroglycerin dilates veins and decreases venous return (preload) = decreased cardiac oxygen demand
- in variant angina, nitroglycerin prevents or reduces coronary artery spasm = increased oxygen supply
105
nitroglycerin indications
- acute angina attacks
- prophylaxis of chronic stable or variant angina
106
nitroglycerin AEs
- HA
- hypotension
- reflex tachycardia
- tolerance
107
nitroglycerin administration
- nitrostat (PO) = given 3x every 5 minutes (don't take more than three doses)
- topical = 1-2 inches every 4-6 hrs during the day
- IV = may be needed if SL is ineffective
108
nitroglycerin nursing administration
- monitor drug interactions with antihypertensives
- educate pt on avoiding alcohol, AEs, and proper use of medication
- assess BP and HR before administration
109
ranolazine (Ranexa) class
antianginal
110
ranolazine (Ranexa) MOA
lowers cardiac oxygen demand; improves exercise tolerance and decreases pain
111
ranolazine (Ranexa) indications
angina (not used for variant)
112
ranolazine (Ranexa) AEs
- may prolong QT interval
- if being used for ventricular dysrhythmias it can cause Torsades de Pointes
NURS 3303
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